| NPI | 1205010360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A112946) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OR MD29106) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125-048033) | |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2020-03-01 |